Negative Pressure Wound Therapy

Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA, WCC

For those of you who cannot remember the now deceased comedian Chris Farley, did not find his humor funny or simply cannot remember any of his memorable performances; I suggest you move on to another, less controversial, "here's how to use scissors" type of blog.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

Finding the key to unlocking a non-healing chronic wound keeps us awake at night. Though we have, as bedside clinicians, learned much about the physiology and biochemistry of chronic wounds over the past decade, wound healing is not an exact science. Negative pressure wound therapy (NPWT) has become standard care for certain chronic wounds. Sometimes, however, wounds treated with this therapy do not progress as readily as we think that they should. This has led us to consider combining other wound care products with NPWT. This article will examine the rationale for using three products in combination with negative pressure.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

We just can’t resist New Year’s resolutions. This is the time of year when we reflect back on aspects of the year that is ending, and determine to do some things differently in the year that is dawning. If you are reading this, then you likely use negative pressure wound therapy (NPWT) in your clinical practice. If you use this valuable therapy to help your patients’ wounds to heal, then you are aware that NPWT comes with risks. Our friends in the legal profession certainly understand this. Look back at the FDA Safety Alert issued in February 2011 in response to increased injuries among patients receiving NPWT. The FDA concluded that many of the injuries and deaths were related to insufficient observation of wound dressings and lack of patient teaching.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

How did you acquire your knowledge and skills around the application of NPWT dressings? Most of us learned by observing another clinician doing dressing applications, or from a manufacturer's representative. We likely just imitated what they did, largely winging it. In my work over the past few years, I have been surprised to learn that many excellent clinicians have gaps in technical ability. This article is intended to review principles of NPWT dressing application to increase the accuracy of your techniques. These tips are distilled from principles that are typical of manufacturer guidelines. It is always recommended that you read and follow the manufacturer’s guidelines for the product that you are using.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

Wounds treated with negative pressure wound therapy (NPWT) are not often straightforward. They occur in interesting places, have anything from slough to hardware visible in the bases, and have nooks and crannies that are not visible to the clinicians peering into the wound. A gentle probe is necessary during wound assessment to identify tunnels and undermined areas. I prefer to gently probe first with my gloved finger (I have small hands) because I can identify hidden structures and other oddities. Then I will use a swab to measure how far the tunnel or undermining extends. Once hidden dead spaces have been identified, clinicians can select the best strategy to bring them to closure. Herein are several techniques employed by clinicians to close undermined and tunneled areas.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

I am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy (NPWT). As a clinician practicing in the outpatient and home care settings, it was not unusual for patients to have to take a "holiday" from negative pressure. Treatment was often put on hold for several days to allow skin to recover. Putting negative pressure on hold not only caused a potential delay in forward progress in the wound, but it also created the need for increased dressing change visits for the home care patient. While maceration is reported in wounds located anywhere on the body, it seems to be most prevalent on skin of the lower extremity.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

Negative Pressure Wound Therapy (NPWT) has become standard of care for many wound types. Any clinician who works with NPWT dressings will report that a significant number of wounds will develop a malodor, commonly referred to as a “VAC stink.” In response to malodor, clinicians often opt to give the wound a NPWT holiday, which can delay wound closure. In thi article we will look at factors that contribute to malodor, and interventions that might reduce it.

Laurie Swezey's picture
wound tunneling, undermining

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Tunneling wounds can be difficult to heal and often take several weeks to months to close. The following will discuss tunneling wounds and how negative pressure wound therapy can be used to heal them.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWOCN

Negative pressure wound therapy (NPWT) has become a mainstay in wound management. During the advent years of its use, NPWT was only used to treat large, difficult wounds. Now it is a standard treatment for a wide range of wounds. As a clinician interested in wound management, you are likely using this therapy frequently. But how knowledgeable are you about important aspects of NPWT? The author’s hope is that, as you read these NPWT-focused articles, you will become interested in filling in any “knowledge gaps” that you identify.

Diane Krasner's picture

By Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN

Wound care clinicians who use Negative Pressure Wound Therapy and legal professionals who review NPWT cases should all be focusing on the same standard of wound care issues when it comes to NPWT: